Referral Coordinator in Jacksonville, FL at Crown Services, Inc

Date Posted: 2/4/2021

Job Snapshot

Job Description

Authorization Specialist/Referral Coordinator- Rate $15.00- $16.00/hr

We are looking for a temporary Authorization Specialist to work with our team for approximated 3-5 months. This individual is responsible for obtaining managed care authorizations and verifying patient insurance benefits. Analyzing utilization data from health plans' claims as required. Maintains optimal patient, referring physician and insurance company satisfaction.

SUPERVISION RECEIVED: Office Manager

ESSENTIAL FUNCTIONS:

  • Obtaining required referrals and authorizations prior to services via phone, fax, on-line, etc.
  • Review office schedules daily for patients requiring authorizations, referrals, pre-notification, and insurance eligibility verification.
  • Obtaining retro-authorizations or updating existing authorizations in a timely manner.
  • Inputting/updating authorization information into EHR.
  • Updates the patient account with details of the insurance verification.
  • Identifies deductibles, co-pays, and self-pay accounts. Identifies large dollar DME accounts.
  • Notifying the appropriate staff members if treatment or service is denied.
  • Coordinating with the Financial Counselor necessary information for patient discussions.
  • Working with the provider if a peer-to-peer review is necessary or requested by the payer.
  • Keeping up-to-date on third party payer authorization requirement information.
  • Re-verify all patients monthly for active, current insurance.
  • Assist Collection staff with account questions when presented.
  • Participates in professional development efforts to ensure currency in health care practices and trends.
  • Perform other duties as assigned.

EDUCATION: High School, with 1-2 years experience in healthcare insurance billing and verification, collections and/or authorizations.

KNOWLEDGE:

  • Knowledge of clinic policies and procedures.
  • Knowledge of managed care contracts and utilization.
  • Knowledge of computer systems, programs and spreadsheet applications.
  • Knowledge of medical terminology.
  • Knowledge of CPT/ICD-9

SKILLS:

  • Skill in gathering and reporting claim information.
  • Skill in solving utilization problems.
  • Skill in written and verbal communication and customer relations.

ABILITIES:

  • Ability to work with effectively with medical staff and external agencies.
  • Ability to identify, analyze and solve claim problems.

PHYSICAL/MENTAL DEMANDS:

Requires sitting and standing associated with a normal office environment.

ENVIRONMENTAL/WORKING CONDITIONS:

Normal busy office environment with much telephone work. Occasional evening or weekend work.

Job Requirements

  • Increase referral base for ICFH
  • Enter referral information in the computer referral system, faxes or relays communications of the referral
  • Build relationships with referral sources
  • Maintain the internal referral process
  • Ensure that the referral appointment
  • Resolve referral and authorization denials
  • Updating physician/group referral sheets
  • Enter referral information into database
  • Verify insurance information for referral purposes and process insurance information for referral patients
  • Take messages from the referral line
  • Provide internal and external referral coordination
  • Execute all aspects of the referral process
  • Conducting initial insurance verification to ensure referral
  • Obtain additional information regarding the referral request
  • Keeping all medical assistant's referral books
  • Take referral from referral source via phone, fax, email, Clinical liaison
  • Investigate information contained in the files
  • Prepare and accurately process referral and pre-authorization paperwork
  • Managing the marketing and referral email in boxes
  • Schedule referral appointments directly on behalf of patient